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Transcript of Loss
1. What type(s) of psychological loss can you identify?
2.What nursing interventions could you implement for Wilson as a nursing student to support his psychological loss? Case Study Loss Mr. Smith is a 57 year old male, admitted with right leg ischemia. Because of MRSA, Mr. Smith was not only put in contact isolation, but his toes of the right leg had also became necrotic. Due to MRSA infection, physicians decided that it was the best to do an open amputation, where they wait for his necrotic toes to fall off to prevent the spread of infection. Few weeks later, Mr. Smith's PCA was taken away because he started to become addicted to the medication, and it was causing the development of respiratory depression, where Mr. Smith took 3 breaths/minute while he was sleeping, leading to the decrease of O2 saturation to a dangerous level.
1. How do you think Mr. Smith's situation affected him physically?
2. What nursing interventions could you implement as a nursing student? Biological / Physical Sociological Psychological Biological / Physical Loss The Experience of Loss
The 5 Stages of Grief
The 5 Stages of Grief
-Denial – Individuals deny the reality of the situation which acts to rationalize their overwhelming feelings
-Anger – An expression of their pain as denial subsides and realization of the reality takes place
-Bargaining – A response to the feelings of helplessness and vulnerability in which individuals attempt to regain feeling of control through waging their actions
-Depression – in response to either the practical implications of the loss, or through more subtle or private ways.
-Acceptance – A deeply individual and personal experience in which one can come to terms with the circumstances of their loss Defining Loss in Patients: An Alternative Approach
-Crisis - Life is disrupted. Feelings of sadness, anxiety, anger or guilt
-Unity – Patient needs are the priority. Includes all treatment, social supports and gathering of information
-Upheaval – Characterized by difficulty communicating feelings of upheaval or concern between members involved
-Resolution – Those involved come to terms with the final diagnosis and take the appropriate steps for the impending outcome
-Renewal – The time in which individuals adjust to the loss and their changing roles How can we provide support for our patients
who are experiencing loss? John is a construction worker currently contracted in the Yukon. He is the primary income provider for his wife and two children. While on the job, John falls from a height of two stories high and is admitted with a broken leg. The current prognosis is that he will not be able to work again for at least a few months. Due to an economic down fall, many of his fellow coworkers were laid off with little notice and no compensation. This caused tension to arise between him and his wife due to financial strains and his insecurities about his future ability to provide for his family. His family is his only support system, therefore risking his sociological well-being.
1. What type(s) of sociological loss can you identify?
2. Identify the determinants of health affected and why? References Sociology Sociological Losses Role Performance "Psychological health is state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community" (World Health Organization, 2013). Some examples of psychological loss are:
-loss of identity (from divorce, conflict, societal attitudes, job loss..)
-loss of self-esteem (social isolation, surgery, chronic illnesses..)
-loss of happiness (depression)
-loss of self-worth (loss of a job)
-Body image stressors (from stroke, anorexia, obesity, pregnancy, amputation..)
-Role performance stressors (from a loss of satisfying role, changing work environment, and inability to balance career and family) What nursing interventions can we implement for someone experiencing any form of psychological loss? -support
-assess and clarify thoughts and feelings that the individual is experiencing
-become aware of personal values and how they affect clients
-convey a non-judgemental attitude, open posture, eye contact..
-early identification of causative factor (if not already addressed)
-avoid facial expressions that show signs of disgust or shock
-assess clients coping behaviors
-determine what resources are already available for the client
-provide them with available resources
-...any others? Video - Discusses the importance of one form of psychological loss (job loss), the impact it has on people, and what to do about it. Loss of relationship: friendships, loved ones (family members including pets). Causes: divorce, death, illness (e.g. cancer), moving away, and disagreements. Role performance: "‘actual
conduct of a particular individual while on duty in his (or her) position’" (Handsley & Stocks, 2009, p. 27) Find your niche and be the nurse you want to be Get to know the patient (conversations, ask questions, share stories)
Enhance the care you provide beyond the illness
Social approach (collaborative partnerships) What some nursing interventions to help with sociological loss? Social support groups
Be present, take the time to communicate with the clients
Explore support systems of the patient (family, friends, pets, organizations, coworkers, etc)
Referrals to organizations/institutions (e.g. Wellspring)
Promote strong nurse-client relationship (strengthen emotional support)
Volunteer (share experiences and expertise) Loss of Role – occupation, job, friend, loss of purpose Loss of social support systems: patient could develop feelings of loneliness and hopelessness Loss of Control – natural or human-caused disasters, accidents, changes in social conditions, hospitalization of loved one, sudden illness. Can lead to loss and strains in relationships Sociology: the study of humans in the context of society and communities. Includes: what we do, how we think, and interact with one another. Losses that are related to illness, ability to carry out tasks or activities, or death.
- Loss of a limb (amputation)
- Loss of hearing
- Loss of mobility Pain & Loss Pain can affect an individual's ability to carry out certain tasks and/or daily activities.
"Inactivity leads to physical deconditioning. (Potter and Perry, 2101, p.1023)
Pain can also affect sleep, hygiene, exercise, and diet. (Cohn, 2013, para. 2; Potter and Perry, 2010, p. 1023) References Potter, P.A. & Perry, A. G. (2010). Fundamentals of nursing. In J. C.
Ross-Kerr & M. J. Wood (Eds.). Chapter 2: The Canadian health care system (pp. 14-23). Toronto, Canada: Mosby Elsvier
Reid, J., McKenna, H., Fitzsimons, D. & McCance, T. (2009). The
experience of cancer cachexia: a qualitative study of advanced cancer patients and their family members. International Journal Of Nursing Studies, 46, 606-616. doi:10.1016/j.ijnurstu.2008.10.012
Wicks, L. & Mitchell, A. (2010).The adolescent cancer experience:
loss of control and benefit finding. European Journal Of Cancer Care, 19, 778-785. doi: 10.1111/j.1365-2354.2009.01139.x
World Health Organization (2013).Mental health: A state of well-
being. Retrieved April 4th, 2013 from http://www.who.int/features/factfiles/mentalhealth/en/ Adultswim. (2009, Septemper 7). Robot chicken: Quicksand. Retrieved April 3, 2013, from
http://www.youtube.com/watch?v=G_Z3lmidm r Y
Axelrod, J. (2006). The 5 stages of loss and grief. Retrieved from
Cambridge Credit. (2010, February 8). The Psychological Impact of Unemployment.
Retrieved April 3, 2013, from
Cohn. (2013). Types of loss, Retrieve on April 1, 2013, from
Handsley, S., & Stocks, S. (2009). Sociology and nursing: role performance in a
psychiatric setting. International Journal Of Mental Health Nursing, 18(1), 26-34. doi:2070/10.1111/j.1447-0349.2008.00571.x
Hart, J. (2012). Moving through loss. Alternative and Complimentarty
Therapies, doi: 10.1089/act.2012.18301
Harvard Health Publications. (2011). Beyond the five stages of grief. Harvard
Mental Health Letter, Retrieved from www.health.harvard.edu
Kessler, D. (2013). The five stages of grief. Retrieved from
Mudge, E. J., Meaume,S., Woo,K., Sibbald, G. R., Price, P. (2008). Patients'
experience of wound-related pain: an international perspective. EWMA Journal,8(2):19-28.
Potter, P.A. & Perry, A. G. (2010). Fundamentals of nursing. In J. C. Ross-
Kerr & M. J. Wood (Eds.). Chapter 42: Pain and comfort (pp. 1009-1042). Toronto, Canada: Mosby Elsvier